P - 35181From: unknown
Page: 1/2 Date: 7/19/2011 8:54;11 AM
Building BUILDING
Insp�ctiuns RESIDENT'IAL AP�'LYCATYC��
763-572-3604 ��T,�r ��' �,+�D���
76�`5�2��977 FAX EFFECTIVCI•1•2011
17ATE /�/ ���/
ST`�"E A17Il�SS ��
THIS API'LICANT IS:
P�tOPERTY QWN��2/
T�NANT
C4NTAA�TQR
SU�MIT' A COi'Y Ofi
�'OT� STATL T,YC�N'SL�
nr�n c�rrr�car� o�
tNSV�rrc�
TYPE
oF woRx:
YOCICt �MACC, AnDR�SS
❑ owrrEx p�oxrr�c•roa
aun�ss: /�'''�l G'ro�vn �'d .��'
PHOI�IS: �JG 3 ".S7'Y�' 9�Ld .:�
srnr�e �rcB�sB
r�rorr� .�G.: �- �3�` /G �
❑ sn�rcr.� xa�a.�n�r�w c�,rrsrn�rcnorr
d TWO FAM[LY/NCW CON3TPiUCTi�N
O BRSEMENTFINISH
❑ 1��CK
q NGW tIOMG CONSTRUCTION
0 MAIN'CENANGFJitEPAIR
n�sc�rB� wo�rc ��rrrc norr�:�rra�
SIZG G1F IMPRQV�MENT
OR OFING
�rcrr.m�� or sQua,�r:s .L,�_
R
PROPOSED SIZE:
rCtQPOSED T�ECGHT:
SIll1NG
O Vieyl
O Aiuminum
d C1thW
�
mr r�crs�irro opr•.�rrras o�rCe arro
Oft FpR NBW OpENINGS-17PSCTtCBB SIZB OIF
OPF.I+IING CFIANGC3 Bc
A,�,T.�
TOTAL JOB VALUATION
Permit Fee '
Pl�n Review
Fire Surcharge
Surcharge
License 5tlrcl�argc
SA,C Charge
Curb Cut Escrow
Erosion Control
Park Fee
�aewerMain Chsrge
TotAI Due
r r.�,n c�tr N�nr�
' Ct'cY ,
�n�c ��d3—
sr2�
ST'ORtFS
as�n A w�r+o
� ❑ DRAIN TI
❑ O�ER
INO POOL
O ADDIT[ON
D REMODEL[NQ
-�.��c�r.�'
WIDTFi
�iQU3E ONLY
❑ iiOYJ'Sli � CAIRRGL
❑ ATTACH�D GARAGB
❑ DETACHED 4A!{AQE
❑So�t
O 7'rim
� FasGia
r.ocnrrorr ox wrrrnows
i'ermit No. �ir�°' I'L'
Recei�ed B�: ;J" F'1 Y
Date ��� . I( l� 1, q 2 11
8A3 :MRMT RMOD �L(N C SMiT:
i. Existing Nloor @'lpn
2. Proposed tlo� plea
3. List of stn�ural membpr9 Cp be used
Y'O!? NE'UV COA1STitUCC10N t�VGL{1DiiVCr DECIC$,
�DTTT�NS. � PtDRC�S 3�I�1�TT':
1. 3iDO PIarJ3urvoy sl+owing tha txisiin�g stsucqffe9
end propoaod projext.
z. 7'wo seta of ccmBtructian ples�s
3. incrgy Catculatear►s
FOit WINT30WS — PROYtD$ U•VALU� ANp
MANCJrACTURE STiCK�R (3N W1NDi3W.
arr v�.t,unT�ar►, YNCL�I�YNG THE CQST OF LA,BOA AND
_. (CrST1VC T,� 199y CJ!.B.0 ��� SC�i�nUL�)
See Back Page for Fae Schedulc
65% of Building Permit Fee
.041 times tho total job �valuation
_0005 x Pcrmit V�IusCion Minimum $5.00
$5.00 {Statc Liecnsed Residential Contraatora)
$22�0 per SAC Unit (Plsns to M't�U'CC ior dtterminatean)
t} + b ft = ft x$25� $
$4Sp Conscrvation Plan Revitr�+ .
Fee Dctemiint8 b� �ngintccing
Agrecment necessary ( ) Non NecBasary ( )
TE�iS TS AbT App�.yCATI�N' x0�t A pETLMY'C-N07' VALID UTtTlL PROCESSED
T hereb�+ apply for a building perntis a�nd T aekno�vledge that the infarmat�an above �s complett and accuratc; ti►�t t�a wc�rk will be in
confonnance with the ordinancos and codas af the City of Fridlcy and with the 11�tinnesota Constcucdon Crrdes; that T undor5tattd this i8 not a
permit but only an applic�tion for a permit and work 'ts not to start withaut a permit on site; that thc �t�vorl� will be in Reeord�tnet +wlth the
approved plan in the oase of ' s r ew and approval of pla� �� , � �J
SIQNATI)RE OF APPLICANT RiNT NA[� 6r /�cr�s(/ 17A'I�a i/%��/,J
AppltO'VAL 1NSp�C1'OR SI rLlRE
__ PLEASE NO . SEPARATL' PERt+�lITS ARE REQUIREU F(JR PLLJI�TNG, ELECTRICAL, AND ivI�CHAl+7ICAL'WOR�